| When we wrote The People's Guide to Deadly Drug | | | | unless a knowledgeable health professional is carefully |
| Interactions, we included a section on herb-drug | | | | monitoring your progress. St. John's wort may also |
| combinations. We were concerned about the | | | | affect the metabolism of medications such as |
| possibility that many people would take herbs along | | | | olanzapine (Zyprexa) and other antidepressants like |
| with their medications without realizing that there | | | | amitriptyline (Elavil) and imipramine (Tofranil). Other |
| could be a risk of incompatibility. | | | | drugs that may be affected by this herb include |
| We have become even more alarmed about this | | | | caffeine, clozapine (Clo-zaril), haloperidol (Haldol), |
| potential danger as we have collected the information | | | | theophylline (Theo-Dur), warfarin (Coumadin), and |
| for this book. Many herbs impact a variety of | | | | zileuton (Zyflo). Ginkgo, kava, and valerian may also |
| biochemical systems and could have a profound | | | | affect these drugs. Blood levels of the medications |
| effect on the way drugs exert their activity. | | | | may rise, potentially increasing the risk of reactions. |
| Unfortunately, drug companies have little incentive to | | | | We are very concerned about another interaction |
| do the research that would tell us more about such | | | | with St. John's wort, with light rather than medication. |
| interactions. And herb manufacturers rarely have the | | | | Joan Roberts, Ph.D., of Fordham University, has been |
| resources or the inclination to explore this crucial area | | | | studying the effects of light and drugs on the eye |
| themselves. With 60 million people now regularly | | | | for decades. She has discovered that hypericin, an |
| taking herbs and dietary supplements and also utilizing | | | | ingredient in St. John's wort, reacts to ultraviolet and |
| prescription and over-the-counter medicines, the | | | | visible light. When activated, hypericin becomes toxic |
| possibility for dangerous interactions is great. | | | | to the lens and retina of the eye, increasing the risk |
| Each herb summary in the last section of this book | | | | of cataracts or macular degeneration over time. |
| contains information on interactions. We encourage | | | | Because sunglasses don't screen out visible light, they |
| you to consult this information before combining any | | | | can't protect people from this danger. We suggest |
| drugs with herbal remedies. Please recognize that not | | | | that people taking St. John's wort stay out of bright |
| all interactions have been discovered or reported in | | | | light completely. |
| the literature. Knowledge in this field is constantly | | | | GINKGO AND COUMADIN |
| changing, so there may be interactions we have not | | | | Ginkgo has an impact on blood clotting by affecting |
| been able to include. Here are just a few of the | | | | something called PAF (platelet activating factor). We |
| more alarming combinations: | | | | fear that combining ginkgo and Coumadin, a powerful |
| LICORICE AND LANOXIN | | | | anticoagulant, may increase the risk for bleeding. In |
| Licorice may seem like an innocuous candy, but the | | | | fact, several cases have been reported in which |
| herb has very powerful hormone like effects. Regular | | | | people taking ginkgo and Coumadin have suffered |
| use of this herbal medicine can deplete the body of | | | | hemorrhages. Other herbs that may also increase the |
| potassium. In combination with the heart drug | | | | action of Coumadin include cayenne, chamomile, dong |
| Lanoxin, a low potassium level could disrupt the | | | | quai, echinacea, feverfew, garlic, ginger, hawthorn, |
| heart's regular rhythm. This interaction is especially | | | | horse chestnut, juniper, and licorice. Herbs that may |
| dangerous if a person is also taking diuretics such as | | | | counteract Coumadin include ginseng, goldenseal, and |
| hydrochlorothiazide or Lasix that cause potassium | | | | pau d'arco. Anyone taking Coumadin and herbs needs |
| loss. Strong herbal laxatives such as senna, cascara | | | | to have very careful blood monitoring frequent tests |
| sagrada, or aloe could also throw body electrolytes | | | | for blood clotting (prothrombin times and INR). |
| like potassium out of balance and make the | | | | Aspirin has blood-thinning power and might also |
| combination of licorice and Lanoxin potentially deadly. | | | | interact with many herbs, including ginkgo, garlic, |
| Even without Lanoxin, taking licorice with aloe or | | | | feverfew, ginger, hawthorn, juniper, and licorice. One |
| senna could trigger a life-threatening arrhythmia. | | | | man began bleeding inside his eye after starting on |
| KAVA AND XANAX | | | | ginkgo in addition to his regular aspirin therapy. |
| Kava-kava is one of the most sedating herbs people | | | | MA HUANG AND ANTIDEPRESSANTS |
| can use to help them sleep or cope with anxiety. | | | | Ma huang, also known as ephedra, must never be |
| One person thought he would switch to this herb but | | | | combined with MAO inhibitors such as Marplan, Nardil, |
| started using kava while he was still taking Xanax | | | | or Parnate, used to treat depression. This interaction |
| (alprazolam). He experienced a coma like episode as a | | | | could send blood pressure dangerously high. Do not |
| consequence of this combination and ended up in the | | | | take ma huang within two weeks of using an MAO |
| hospital. Kava might interact in a similar way with | | | | inhibitor. Deaths have been reported with use of ma |
| other anti anxiety drugs such as chlordiazepoxide | | | | huang. Yohimbe, an herbal treatment for impotence, |
| (Librium), diazepam (Valium), flurazepam (Dalmane), | | | | is also potentially dangerous with MAO inhibitors. Ma |
| halazapam (Paxipam), lorazepam (Ativan), and | | | | huang is incompatible with heart medicines such as |
| temazepam (Restoril). Valerian, another herbal | | | | Lanoxin and with the anesthetic halothane. Serious |
| sedative, may also interact with these drugs or with | | | | disruption of heart rhythm may occur. Ma huang must |
| kava-kava. We recommend against mixing either of | | | | not be combined with ergot or its derivative |
| these herbs with each other, with alcohol, or any | | | | ergotamine (Cafergot), or blood pressure could |
| other sedating compound, including diphenhydramine. | | | | become very elevated. |
| This is found in many nighttime pain formulas such as | | | | GLUCOMANNANAND DIABETA |
| Tylenol PM. | | | | Glucomannan, a dietary fiber sometimes |
| ST. JOHN'S WORT AND PAXIL | | | | recommended for weight loss, can lower blood sugar. |
| St. John's wort definitely modifies brain chemistry. Its | | | | Diabetics using this fiber need to monitor blood sugar |
| effectiveness as an antidepressant depends on such | | | | more closely. The dose of diabetes medicines such as |
| activity. One woman who took Paxil together with | | | | DiaBeta, Diabinese, Dymelor, Glucotrol, Glynase, |
| St. John's wort became groggy and incoherent. She | | | | Micronase, Orinase, Tolamide, or Tolinase may need |
| was also nauseated, weak, and so tired she could | | | | to be adjusted. Another diabetes pill, Glucophage, |
| hardly get out of bed. With millions of people taking | | | | may not be absorbed as well if it is taken before a |
| antidepressants such as Prozac, Paxil, and Zoloft, we | | | | meal containing a different dietary fiber, guar gum. |
| fear that this interaction may become more common. | | | | This thickener is used in salad dressing, frozen |
| It is potentially dangerous. Please do not combine St. | | | | yogurt, and other low-fat foods to improve their |
| John's wort with any prescription antidepressants | | | | texture. |